帕金森病合并认知功能障碍与脑白质纤维束改变的关系
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摘要
目的探讨帕金森病(PD)合并认知功能障碍与认知相关脑白质纤维束改变的关系。方法纳入PD患者35例,根据蒙特利尔认知评估量表(MoCA)评分将PD患者分为PD认知功能正常组(PD-nCI,n=14)和PD认知功能障碍组(PD-CI,n=21);另选择同期行查体的健康志愿者20名作为对照组。所有受试者行弥散张量成像(DTI)检查,通过基于纤维束的空间统计分析(tract-based spatial statistics,TBSS)方法选出与认知相关的脑白质纤维束,并测量各纤维束部分各向异性(fractional anisotropy,FA)值。比较各组不同纤维束FA值差异,采用Pearson相关分析法分析PD-CI组差异有统计学意义的纤维束FA值与MoCA评分的相关性。结果(1)3组间胼胝体膝部、胼胝体体部、胼胝体压部、右扣带回(海马)、左扣带回(海马)、右穹窿/终纹、左穹窿/终纹、右上额枕束、左上额枕束FA值比较存在统计学差异(均P<0.05),PD-nCI组和PD-CI组间胼胝体膝部、胼胝体体部、胼胝体压部、右扣带回(海马)、左扣带回(海马)、左穹窿/终纹、右上额枕束、左上额枕束FA值比较存在统计学差异(均P<0.05);(2)PD-CI组胼胝体压部、右扣带回(海马)、右上额枕束、左上额枕束FA值与MoCA评分呈正相关(均P<0.05)。结论 PD患者认知功能损害程度与胼胝体压部、右扣带回(海马)、右上额枕束和左上额枕束等纤维束病变严重程度呈正相关。
Objective To investigate the relationship between cognitive dysfunction of Parkinson's disease(PD)and cognitive-related changes in white matter fiber bundles.Methods Thirty-five patients with PD were enrolled.PD patients were divided into PD normal cognitive function group(PD-nCI,n=14)and PD cognitive dysfunction group(PD-CI,n=21)according to the Montreal Cognitive Assessment Scale(MoCA)score.Twenty healthy volunteers who were examined at the same time were selected as the control group.All the subjects underwent diffusion tensor imaging(DTI)examination,and brain-white matter fiber bundles related to cognition were selected by tract-based spatial statistics(TBSS)method,and each fiber bundle fractional anisotropy(FA)was measured.The FA values of different fiber bundles in each group were compared.Pearson correlation analysis was used to analyze the correlation between FA values of fiber bundles and the MoCA score.Results(1)There were statistical differences in FA values of genu of corpus callosum,body of corpus callosum,splenium of corpus callosum,right cingulum(hippocampus),left cingulum(hippocampus),right fornix(cres)/stria terminalis,left fornix(cres)/stria terminalis,right superior fronto-occipital fasciculus,left superior fronto-occipital fasciculus between the 3 groups(all P<0.05).There were statistical differences in FA values of genu of corpus callosum,body of corpus callosum,splenium of corpus callosum,right cingulum(hippocampus),left cingulum(hippocampus),left fornix(cres)/stria terminalis,right superior frontooccipital fasciculus,and left superior fronto-occipital fasciculus between the PD-nCI group and the PD-CI group(all P<0.05).(2)The FA values of corpus callosum,right cingulum(hippocampus),right superior frontooccipital fasciculus,left superior fronto-occipital fasciculus were positively correlated with MoCA score in the PDCI group(all P<0.05).Conclusions The degree of cognitive impairment in patients with PD was positively correlated with the severity of splenium of corpus callosum,right cingulum(hippocampus),right superior frontooccipital fasciculus,and left superior fronto-occipital fasciculus impairments.
Objective To investigate the relationship between cognitive dysfunction of Parkinson's disease(PD)and cognitive-related changes in white matter fiber bundles.Methods Thirty-five patients with PD were enrolled.PD patients were divided into PD normal cognitive function group(PD-nCI,n=14)and PD cognitive dysfunction group(PD-CI,n=21)according to the Montreal Cognitive Assessment Scale(MoCA)score.Twenty healthy volunteers who were examined at the same time were selected as the control group.All the subjects underwent diffusion tensor imaging(DTI)examination,and brain-white matter fiber bundles related to cognition were selected by tract-based spatial statistics(TBSS)method,and each fiber bundle fractional anisotropy(FA)was measured.The FA values of different fiber bundles in each group were compared.Pearson correlation analysis was used to analyze the correlation between FA values of fiber bundles and the MoCA score.Results(1)There were statistical differences in FA values of genu of corpus callosum,body of corpus callosum,splenium of corpus callosum,right cingulum(hippocampus),left cingulum(hippocampus),right fornix(cres)/stria terminalis,left fornix(cres)/stria terminalis,right superior fronto-occipital fasciculus,left superior fronto-occipital fasciculus between the 3 groups(all P<0.05).There were statistical differences in FA values of genu of corpus callosum,body of corpus callosum,splenium of corpus callosum,right cingulum(hippocampus),left cingulum(hippocampus),left fornix(cres)/stria terminalis,right superior frontooccipital fasciculus,and left superior fronto-occipital fasciculus between the PD-nCI group and the PD-CI group(all P<0.05).(2)The FA values of corpus callosum,right cingulum(hippocampus),right superior frontooccipital fasciculus,left superior fronto-occipital fasciculus were positively correlated with MoCA score in the PDCI group(all P<0.05).Conclusions The degree of cognitive impairment in patients with PD was positively correlated with the severity of splenium of corpus callosum,right cingulum(hippocampus),right superior frontooccipital fasciculus,and left superior fronto-occipital fasciculus impairments.
引文
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[28]Borroni B,Premi E,Formenti A,et al.Structural and functional imaging study in dementia with Lewy bodies and Parkinsons disease dementia[J]. Parkinsonism Relat Disord,2015,21(9):1049-1055.
[29]Levy G,Schupf N,Tang MX,et al.Combined effect of age and severity on the risk of dementia in Parkinsons disease[J].Ann Neurol,2002,51(6):722-729.
[2]Williams-Gray CH,Mason SL,Evans JR,et al.The campaign study of Parkinsons disease:10-year outlook in an incident population based cohort[J].J Neurol Neurosurg Psychiatry,2013,84(11):1258-1264.
[3]Hely MA,Reid WG,Adena MA,et al.The sydney multicenter study of Parkinsons disease:The inevitability of dementia at20years[J].Mov Disord,2008,23(6):837-844.
[4]Agosta F,Canu E,Stojkovi T,et al.The topography of brain damage at different stages of Parkinsons disease[J].Hum Brain Mapp,2013,34(11):2798-2807.
[5]Kim HJ,Kim SJ,Kim HS,et al.Alterations of mean diffusivity in brain white matter and deep gray matter in Parkinsons disease[J].Neurosci Lett,2013,550:64-68.
[6]Postuma RB,Berg D,Stern M,et al.MDS clinical diagnostic criteria for Parkinsons disease[J].Mov Disord,2015,30(12):1591-1601.
[7]Uekermann J,Daum I,Peters S,et al.Depressed mood and executive dysfunction in early Parkinsons disease[J].Acta Neurol Scand,2003,107(5):341-348.
[8]Donaldson IM.James Parkinsons essay on the shaking palsy[J].J R Coll Physicians Edinb,2015,45(1):84-86.
[9]Broeders M,Velseboer DC,de Bie R,et al.Cognitive change in newly-diagnosed patients with Parkinsons disease:a 5-year follow-up study[J].J Int Neuropsychol Soc,2013,19(6):695-708
[10]Caviness JN,Driver-Dunckley E,Connor DJ,et al.Defining mild cognitive impairment in Parkinsons disease[J].Mov Disord,2007,22(9):1272-1277.
[11]Williams-Gray CH,Foltynie T,Brayne CE,et al.Evolution of cognitive dysfunction in an incident Parkinsons disease cohort[J].Brain,2007,130(Pt 7):1787-1798.
[12]Hely MA,Reid WG,Adena MA,et al.The Sydney multicenter study of Parkinsons disease:the inevitability of dementia at 20years[J].Mov Disord,2008,23(6):837-844.
[13]Poletti M,Emre M,Bonuccelli U.Mild cognitive impairment and cognitivereserveinParkinsonsdisease[J].Parkinsonism Relat Disord,2011,17(8):579-586.
[14] Levin BE,Katzen HL.Early cognitive changes and nondementing behavioral abnormalities in Parkinsons disease[J].Adv Neurol,2005,96:84-94.
[15]Cruise KE,Bucks RS,Loftus AM,et al.Exercise and Parkinsons:benefits for cognition and quality of life[J].Acta Neurol Scand,2011,123(1):13-19.
[16]Hilker R,Thomas AV,Klein JC,et al.Dementia in Parkinson disease functional imaging of cholinergic and dopaminergic pathways[J].Neurology,2005,65(11):1716-1722.
[17]Basser PJ,Mattiello J,LeBihan D.MR diffusion tensor spectroscopy and imaging[J].Biophys J,1994,66(1):259-267.
[18] Minati L,Grisoli M,Bruzzone MG.MR spectroscopy,functional MRI,and diffusion-tensor imaging in the aging brain:A conceptual review[J].J Geriatr Psychiatry Neurol,2007,20(1):3-21.
[19]Nicoletti G,Tonon C,Lodi R,et al.Apparent diffusion coefficient of the superior cerebellar peduncle differentiates progressive supranuclear palsy from Parkinsons disease[J].Mov Disord,2008,23(16):2370-2376.
[20]Gattellaro G,Minati L,Grisoli M,et al.White matter involvement in idiopathic Parkinson disease:a diffusion tensor imaging study[J].AJNR Am J Neuroradiol,2009,30(6):1222-1226.
[21]Hattori T,Orimo S,Aoki S,et al.Cognitive status correlates with white matter alteration in Parkinsons disease[J].Hum Brain Mapp,2012,33(3):727-739.
[22]Deng B,Zhang Y,WangL,et al.Diffusion tensor imaging reveals white matter changes associated with cognitive status in patients with Parkinsons disease[J].Am J Alzheimers Dis Other Demen,2013,28(2):154-164.
[23]Theilmann RJ,Reed JD,Song DD,et al.. White-matter changes correlate with cognitive functioning in Parkinsons disease[J].Front Neurol,2013,4:37.
[24]Zgaljardic DJ,Borod JC,Foldi NS,et al.A review of the cognitive and behavioral sequelae of Parkinsons disease:relationship to frontostriatal circuitry[J]. Cogn Behav Neurol,2003,16(4):193-210.
[25]Hansch EC,Syndulko K,Cohen SN,et al.Cognition in parkinson disease:an event-related potential perspective[J].Ann Neurol,1982,11(6):599-607.
[26]Alexander GE,DeLong MR,Strick PL.Parallel organization of functionally segregated circuits linking basal ganglia and cortex[J].Annu Rev Neurosci,1986,9:357-381.
[27]Steiner I,Gomori JM,Melamed E.Features of brain atrophy in Parkinsonsdisease. ACTscanstudy[J].Neuroradiology,1985,27(2):158-160.
[28]Borroni B,Premi E,Formenti A,et al.Structural and functional imaging study in dementia with Lewy bodies and Parkinsons disease dementia[J]. Parkinsonism Relat Disord,2015,21(9):1049-1055.
[29]Levy G,Schupf N,Tang MX,et al.Combined effect of age and severity on the risk of dementia in Parkinsons disease[J].Ann Neurol,2002,51(6):722-729.